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By Brianna Routh, PhD, RDN, Assistant Professor and MSU Extension Food and Family Specialist; and Gina Kucmanic, Montana State University Dietetic Intern

Welcoming a child into your home is a big life change with many rewards and challenges. This is especially true when children have existing food habits that might be different from your own. As of 2022, there are 2,600 children enrolled in foster care in Montana, in addition to 11,000 children being raised by relatives (kin) with no parent present. Children in foster or kin care have often encountered their own challenging life circumstances that can be linked to risky food behaviors. For example, children in foster or kin care are more likely to have experienced household food insecurity or their home did not have enough access to quality and nutritious foods. Children and caregivers bring different food experiences and expectations to the table. Engaging together with food can
provide positive, protective support for long-term wellness. This guide will help identify food behaviors and provide strategies for children to build healthy food relationships.

Why are food patterns important?

Food is important to a child’s growth and development, both physically and mentally. Due to unbalanced diets, children are at risk for low iron, calcium, fiber, folate, magnesium, potassium, and vitamin E. Children in foster and kin care are at higher risk for additional nutrient shortages because of previous life experiences as well. Food behaviors may have immediate and long-term impacts on growth and development.

Common food behaviors to look for among children in Foster/Kinship Care

PICKY EATING AND AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER

Picky eating is when a child may not like or try certain foods. It is developmentally appropriate and common as children learn about new smells, tastes, and textures. For children in foster or kin care, they may be more likely to experience selective or restrictive eating based on past food exposure and parent-child food interactions. Selective food behaviors may also be a connection to parents or previously supported food habits. Picky eating does not impact appetite or growth and generally decreases over time without medical intervention.

Avoidant Restrictive Food Intake Disorder (ARFID) is an extreme type of picky eating often associated with younger children. This can occur because of a negative past food experience, changes in their environment, or mental health. Symptoms may include weight loss, failure to thrive, overall lack of interest in eating, and strong reactions to tastes, textures, or colors of food. This can lead to nutrient deficiencies and mental health and cardiac challenges. 

Tips to try:

  • Find non-food-related opportunities to help childrenfind comfort and connection to loved ones.
  • Start small with exposure to new foods and keep them in a regular rotation.
  • Stick with it and keep food time positive and low stress.
  • Include children in activities in the kitchen.
  • Be a role model by eating the foods suggested for children to eat.

FOOD MAINTENANCE SYNDROME

Food maintenance syndrome is an eating-related behavior where a person feels compelled to overeat or hoard foods. This is often connected to previous experiences of food insecurity, abuse, or maltreatment. This syndrome may look like hoarding food, overeating to the point of being painfully full, stealing
or sneaking food, and even refusing to throw food away. These behaviors can lead to gastrointestinal issues, mental health challenges, and nutrient deficiencies or excesses.

Tips to try:

  • Tell them they will always be able to eat when they’re hungry.
  • Show them or have them help pack snacks if leaving the house.
  • Give them two choices at snack or mealtime to feel less restricted and in control.

PICA-TYPE EATING BEHAVIOR

Pica is an eating-related, compulsive behavior where a person eats non-food items. Pica is seen most often in school-age or younger children. This behavior may be connected to children with mental health, developmental disabilities, or previous experiences with extreme stress or hunger. It may also start as attention-seeking behavior, especially for children who experience parental neglect. While sometimes harmless, pica may cause infection, oral injuries, gastrointestinal problems (diarrhea, constipation), nutrient deficiencies, or more depending on what is eaten.

Tips to try:

  • Seek professional support to identify and treat root cause, and
  • Keep frequently consumed non-food items out of sight and out of reach when possible.

EATING DISORDERS/DISORDERED EATING

Eating disorders are health conditions that affect a person physically, psychologically, and socially. These can include extreme efforts to control weight or food and can interfere with health and daily life. Bulimia nervosa, anorexia nervosa, or binge eating disorder are examples associated with children or teenagers in foster care. This can occur for both girls and boys. Additional irregular eating patterns can be potential signs of disordered eating more broadly such as frequent dieting, chronic weight change, rigid rituals around food or exercise, and a preoccupation with body image.

If you see or suspect any of these behaviors, share concerns with a pediatrician to determine the next steps and develop a plan of care. A plan of care will likely include a dietitian familiar with eating disorders to support the family and the children in care. Avoid discussing weight with your child.

Balanced Food Goal

When approaching a balanced diet, the United States Department of Agriculture has provided research-based guidelines to work towards:

  • Make half of a plate fruits and vegetables and eat a rainbow of colors;
  • Make half of grains whole grains, with foods like whole-grain flour products, oatmeal, and brown rice;
  • Vary protein intake to include meat, poultry, fish, tofu, chickpeas, and lentils; and
  • Move to low-fat or fat-free dairy milk or yogurt.

MyPlate balanced food plate

INTUITIVE EATING (IE) AND FOOD NEUTRALITY

Intuitive eating is a non-diet approach to eating that follows physical hunger cues. As a child grows, they learn different eating behaviors that can lead to them not following their natural hunger. Intuitive eating has been shown to lead to healthier food choices and lower the risk of disordered eating.

Tips to try:

  • Set a good example and practice intuitive eating yourself,
  • Don’t criticize the amount of food they eat, and
  • Teach that there is no “right or “wrong” way to eat.

Food neutrality is a way of viewing food without judgement.

Tips to try:

  • Avoid labeling food as “good versus bad,” or “healthy versus unhealthy,” and
  • Stick with the mindset that all foods fit and serve a purpose.

General Strategies to Achieve Balance with Food

ENGAGE CHILDREN IN THE KITCHEN

Engaging children in food decisions can help build a relationship with them and build their relationship with food.

  • Inviting them to chop, stir, taste and cook during preparation has been proven to increase their willingness to try new foods, help them connect their food to the world around them, and increase their fine motor skills.
  • Involving them in meal planning is also helpful for those with food anxiety and hoarding as it gives them some choice in what they eat.

If a child is not interested in cooking, having them in the kitchen working on something else is a good option to keep them involved and available to talk while food is prepared. USDA MyPlate offers a variety of free games and worksheets for childred in this scenario.

FIND COMMON GROUND

Asking questions is a great way to understand the past experiences and current perspectives of a child newly entering a home. To reduce pressure and build positive relationships, these questions can be a time for all to share without judgment.

  • What is a favorite family food tradition?
  • What is a favorite [descriptive adjective... crunchy, mushy, or sour] food?
  • If a meal has your 3 favorite foods, what would it include?

THINGS TO REMEMBER AS A CAREGIVER…

  • The individual meal doesn’t matter as much as adding variety over time.
  • Avoid talking about weight with your children and focus on fun with food.
  • Help children reconnect with their body’s hunger cues instead of monitoring amounts.
  • At food times, low stress is best. Have fun conversation together when possible and avoid forcing food or using it as a reward or restriction.
  • Provide accessible foods at regularly scheduled times and a child is responsibile to decide what or if they are going to eat.
  • Don’t expect change overnight, but set small goals together as a household to build on easy successes.

Food Resources

Reviewer Acknowledgment

Thanks to Kari Finley, Ph.D., Danial Koltz, Ph.D., Chloe Lundquist, RD and SNAP-Ed Educator, and Autumn Beattie for their review of this MontGuide.

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